Finnish Nurses’ Views on End-of-Life Discussions and a Comparison with Physicians’ Views

Abstract

This study investigated Finnish nurses' experiences and views on end-of-life decision making and compared them with physicians' views. For this purpose, a questionnaire was sent to 800 nurses, of which 51% responded. Most of the nurses had a positive attitude towards and respect for living wills, more often than physicians. Most also believed that a will had an effect on decision making. Almost all of the nurses considered it their responsibility to talk to physicians about respecting living wills. Do-not-resuscitate (DNR) orders were often interpreted to imply partial or complete palliative (symptom-orientated) care, which may cause confusion. Half of the nurses reported that a DNR decision was discussed always or often with a patient who was able to communicate; physicians were more positive in this respect. Surprisingly, many nurses (44%) stated that active treatment continued too long. Two-thirds thought that their opinions were taken into account sufficiently, even though only half believed that, in general, they had some impact.

Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis

“…Further evidence shows that nurses may have a different approach to CPR and DNACPR from physicians 14 and may place more power with the patient and relatives. 71 One study 70 reported that nurses felt that decisions were often made by medical staff in the patients' best interest but another 63 found that 80% of nurses felt that the patient's view should be the decisive factor. Nurses felt that they should be part of the decision-making process.…”

“…63,82 Several studies reported that the nurse may be the first person who broaches the subject of a DNACPR order with the patient, after developing a rapport with them, 14 and they are consulted by the physician about DNACPR status 38,63,67,69,89 and may follow up the physician's discussion to check their understanding. 68 Generally, nurses felt that the overall responsibility should lie with the medical consultant or treating physician 14,63,70 but specialist registrars in one English study 93 had differed in their opinion from that of their consultant at some point (n = 126/235, 54%), with many (n = 198/235, 84%) feeling that the decision should not lie solely with the consultant. Further evidence shows that nurses may have a different approach to CPR and DNACPR from physicians 14 and may place more power with the patient and relatives.…”

“…Of the 26 articles in this theme, 16 included cross-sectional questionnaires or surveys, 38,39,[63][64][65]68,70,74,75,77,78,83,93,[95][96][97] of which six were deemed high quality, 70,78,93,[95][96][97] two were deemed medium quality 38,39 and eight were deemed low quality. [63][64][65]68,74,75,77,83 Eight articles included qualitative methods, [13][14][15]89,91,[97][98][99] of which three were of high quality, 15,89,98 four were of medium quality 13,14,91,97 and one was of low quality. 99 The remaining three articles are reviews of records or audits, …”

“…Thirty-seven articles contributed to this theme and 17 included a questionnaire or survey design. 38,[63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] Of these 17 articles, 12 were deemed low-quality studies, [63][64][65][66][67][68][72][73][74][75][76][77] two were deemed medium quality 38,71 and three were deemed high quality. 69,70,78 Twelve articles included reviews or audits of medical records, registry of deaths or MET calls, 16,75,[79][80][81][82][83][84][85][86][87][88] of which two were of high quality 16,86 two were of medium quality …”

“…The studies reported that the key decision-maker was usually a senior physician, often the person in charge of the patient [63][64][65]71,79,88 who would either make a lone decision 66,79,81,88 or involve other physicians. 63,82 Several studies reported that the nurse may be the first person who broaches the subject of a DNACPR order with the patient, after developing a rapport with them, 14 and they are consulted by the physician about DNACPR status 38,63,67,69,89 and may follow up the physician's discussion to check their understanding.…”